Vaccine acceptability, uptake and completion amongst men who have sex with men: A systematic review, meta-analysis and theoretical framework

Abstract

Background: Due to an increased risk of sexually transmitted infections (STIs), gay, bisexual and other men who have sex with men (MSM) have been recommended to receive vaccinations against human papillomavirus, meningitis C and hepatitis A/B. This review aimed to compare the rates of vaccine acceptability, uptake and completion, and to identify determinants of vaccine outcomes specific to MSM to inform a theoretical framework.Methods: In January 2020 four databases were explored to identify vaccination behaviours and associated factors among MSM. A narrative systematic review and meta-analysis were performed. Data were synthesised for theoretical modelling. Results: Seventy-eight studies, mostly from the USA, were included. The average vaccine acceptability was 63% (median=72%, range: 30%-97%), vaccine uptake 45% (median=42%, range: 5%-100%) and vaccine completion 47% (median=45%, range: 12%-89%). Six categories of factors associated with vaccination acceptability, uptake and completion were conceptualised:Individual (e.g., demographic and psychosocial); Interpersonal (e.g., peer education); Healthcare provider (e.g., vaccine recommendation); Organisational and practice setting (e.g., routine collection of patient sexual orientation information that is integrated into a clinical decision support system); Community environment (e.g., targeted health promotion campaigns); and National, state and local policy environment (e.g., public health guidelines targeting MSM). Conclusion: Despite overall high levels of acceptability, uptake and completion rates were below targets predicted by cost-effectiveness modelling across all recommended vaccines. These parameters may need to be adjusted for more precise estimations of cost-effectiveness. Addressing the multiple levels of determinants, as outlined in our theoretical framework, will help guide interventions to increase vaccine completion among MSM.

HPV vaccination and HIV preexposure prophylaxis (PrEP): Missed opportunities for anal cancer prevention among at risk populations

“…Provider recommendation is a major determinant of HPV vaccination among GBM and HPV vaccine acceptability is high among GBM and TW. 7 , 8 Major barriers are availability and convenience. 6 , 7 , 11 PrEP management visits are a potential venue for targeted HPV vaccine promotion.…”

“…Acceptability is high for HPV vaccination among GBM and TW. 7 , 8 Low uptake of HPV vaccination is likely a result of low awareness and missed opportunities during primary care. 9–11 Qualitative research has identified the need for alternative strategies for HPV vaccine delivery to increase convenience and availability for GBM and TW populations.…”

The Role of Healthcare Providers in Promoting Human Papillomavirus Vaccines among Men Who Have Sex with Men: A Scoping Review

“…Of the unvaccinated, only 40% heard about HPVV [19]. A meta-analysis in 2021 showed that the mean HPVV acceptability rate was 63%, uptake rate was 45% and completion rate was 47% among MSM of 78 studies, mostly performed in the United States [20]. Some of the reasons include the misconception about HPVV being reserved for women, the low perceived threat of HPV-related diseases and the stigma attached to HPVV [21].…”

Predisposing, Enabling, and Need-Related Factors Associated with Human Papillomavirus Vaccination Intentions and Uptake Among Black and Hispanic Sexual and Gender Diverse Adults in the USA

“…Many of the existing studies on HPV vaccine uptake in MSM do not report on an explicit theoretical approach or rely heavily on intrapersonal theories of health behavior (e.g., the theory of planned behavior) [ 13 ]. In the current study, Andersen’s model of healthcare utilization was used to identity predisposing (i.e., sociocultural factors that influence HPV vaccine decisions), enabling (i.e., factors that may facilitate utilization of HPV vaccination), and need based factors (i.e., professional judgment about an individual’s need for HPV vaccination) associated with HPV vaccination (initiation or intentions) among an at risk sample of Black and Hispanic MSM and gender-expansive young adults [ 14 ].…”